Minimally invasive valvuloplasty

Abstract

Objectives: To demonstrate an increase in the cross sectional area and nasal valve angle with the use of upper lateral cartilage suspension sutures. Methods: The prolapsed upper lateral cartilage was identified with intact perichondrium through a careful clinical examination. A minimally invasive incision was made on the skin overlying the bony nasal dorsum and perforations were drilled through the bony dorsum for passage of the suspension sutures. The increased valve area and angle was initially demonstrated on human cadavers. The procedure was offered to patients with medially displaced upper lateral cartilages by trauma who complained of restricted breathing and had a positive Cottle maneuver. Results: The patient uniformly noted a subjective improvement in nasal air flow postoperatively: (1) the external nasal appearance was unchanged, (2) the 2 mm external skin incisions were nearly imperceptible by 10 days, (3) the upper lateral cartilage was tucked up to the distal nasal bones with a nonresorbable suture. Conclusion: This procedure offers patients with upper lateral cartilage displacement another minimally invasive surgical alternative to improve airflow through the valve region of the nose.